l

The content of this website is intended for healthcare professionals only

Cheap drugs promise reduction in breast cancer deaths

Bisphosphonates could save 1,000 lives per year, study shows

Adrian O'Dowd

Friday, 24 July 2015

Two cheap drugs normally used to treat osteoporosis and stop the production of oestrogen, appear to be able to reduce the number of deaths from breast cancer, concludes two studies both published today in The Lancet.

The studies suggest that two different classes of drugs – aromatase inhibitors (AIs) and bisphosphonates – can each improve survival prospects for postmenopausal women with early breast cancer.

Cancer experts have hailed the findings describing them as one of the most important steps forward in breast cancer treatment since the introduction of Herceptin over 10 years ago.

Most breast cancers spread to the bone. Bisphosphonates are currently used to limit the damage caused when cancer has spread to this way by slowing the process that breaks down bone. They are widely used to treat osteoporosis but are currently not licensed to treat early breast cancer.

This potentially makes the bone a more challenging environment for rogue cancer cells to survive in, reducing the risk of the cancer coming back.

The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) – a worldwide collaboration set up 30 years ago by researchers at the University of Oxford to bring together every few years all the evidence from randomised trials on the treatment of early breast cancer – decided to test this.

In the first study*, the researchers brought together evidence from 18,766 women in 26 randomised trials, showing that two to five years of treatment with bisphosphonates, reduced the risk of breast cancer recurring in post-menopausal women, and also significantly extended survival.

In the overall study population, the only clear benefit of bisphosphonates was a 17% reduction in recurrence of cancer in the bone.

However, among postmenopausal women, bisphosphonate treatment produced a larger reduction in bone recurrence of 28% and also reduced the risk of dying from breast cancer by 18% during the first decade after diagnosis.

The bisphosphonate study lead author Professor Robert Coleman, from the University of Sheffield, said: “Our results show that adjuvant bisphosphonates in postmenopausal women prevent around a quarter of bone recurrences and one in six of all breast cancer deaths in the first decade of treatment.

“These simple, well tolerated treatments should now be considered for routine use in the treatment of early breast cancer in women with either a natural or medically induced menopause to both extend survival and reduce the adverse effects of cancer treatments such as the aromatase inhibitors on bone health.”

For the other study**, researchers brought together evidence from 30,000 postmenopausal women in nine randomised trials, showing that five years of treatment with the newer endocrine therapy (i.e. an AI) produced better survival than five years of standard endocrine therapy (tamoxifen).

Compared to tamoxifen, taking AIs for five years further reduced the likelihood of the cancer recurring by about a third (30%), and the risk of dying from breast cancer by around 15% throughout the decade after beginning treatment.

The AI study lead author, Professor Mitch Dowsett of The Royal Marsden and The Institute of Cancer Research, said: “Our global collaboration has revealed that the risk of postmenopausal women with the most common form of breast cancer dying of their disease is reduced by 40% by taking five years of an AI – a significantly greater protection than that offered by tamoxifen.”

Baroness Delyth Morgan, chief executive at the charity Breast Cancer Now, said: “This hotly-awaited, comprehensive study reveals that bisphosphonates could potentially save the lives of around 1,000 women each year in the UK alone, by reducing the risk of their breast cancer spreading.

“We believe that this is one of the most important steps forward in breast cancer treatment since the introduction of Herceptin over 10 years ago, but this time we’re talking about a few pence rather than thousands of pounds, and millions saved by the NHS.”


* Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. The Lancet, 2015. DOI: 10.1016/S0140-6736(15)60908-4

** Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet, 2015. DOI: 10.1016/S0140-6736(15)61074-1

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470